Provider Demographics
NPI:1487044178
Name:DIVINE VOICE OF DESTINY HOSPICE LLC
Entity Type:Organization
Organization Name:DIVINE VOICE OF DESTINY HOSPICE LLC
Other - Org Name:DVOD HOSPICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOMORRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:THD DD
Authorized Official - Phone:601-850-1797
Mailing Address - Street 1:3823 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-6034
Mailing Address - Country:US
Mailing Address - Phone:601-850-1797
Mailing Address - Fax:
Practice Address - Street 1:3823 WARNER AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-6034
Practice Address - Country:US
Practice Address - Phone:601-850-1797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251E00000X, 251G00000X, 253Z00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient